Are we training too many?

[142348]

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PGY-5 here who is was suprised to there were between 170-175 Rad Onc spots this year. seems like when I was applying there were significantly fewer (per charting the match 2006 - 137). looking at why, it seems like a lot of programs increased their resident complements but also a lot of new programs started up (Univ. Miss, Nebraska, Texas AM, LIU, City of Hope, etc.)

I guess the question I have to ask is, is it really necessary to increase the number of spots by 25% in 5 years? I know a lot of people will cite the JCO article that came out a few years ago as evidence we need more rad oncs but the experience of myself and my colleagues that are PGY-5's this year is that job market was tighter than years past based on what we have heard from our seniors, especially in competitive markets. It also seems like that in private practice some groups are holding off on hiring until things with Medicare, healthcare reform are settled so the jobs that should be there due to growth in volume aren't being manfiested. As someone who was a med student 5 years ago it certainly is nice to have more spots available to increaese your chances but on the flip side you don't want to see Rad Onc turn into a Rads or Path situation when it comes to job markets.

I know the ACGME handles residencies and allotments but does ASTRO/ABR provide input to the appropriate number of rad oncs that should be trained in order to meet the needs for retiring physicians and increased patient volumes?

 

[Seldon1985]

I think the ABR is very involved with this process. In particular though, its the RRC (residency review committee) that looks at the quality of each program and examines their proposals for expansion. They cannot, however, look at the economic outlook of the field when recommending whether or not to approve the expansion of Rad Onc, Rads, or Nuc Meds residency spots. In fact, there are even Nuc Meds programs that are still getting approval for expanding their program even though there are virtually no jobs available to graduating residents. Expansion of Rad Onc spots also does not take future job prospects into account. The problem is, in the real world, it is really tough to figure out what the theoretical vs actual need of Rad Onc will be in the future. If we play it conservatively and have just a few spots, then there could be an insufficient number of Rad Onc'ers to treat cancer in the community, possibly leading to further public outcry over the overly regulated nature of residency spots. High demand and low supply works in favor, obviously, of the Rad Onc doc, who can then command a higher salary, etc (name your game, simple economics). If we do end up training too many though, then it is obviously over supply for the demand. Partnership tracks dry up and finding quality jobs becomes very difficult. A good friend of mine is looking for Pathology jobs right now, and it is a rough rough market. The older pathologists who run the larger labs or larger groups are doing great, but the new grads are not getting partnership track offers. These older path guys simply have their pick of new grads who are looking at just few available jobs. Time will tell which way things turn out for Rad Onc. The best thing we can all do is continue to move the field forward in any way possible...

 

[Gfunk6]

I don't possess any insight into if we are training too many Radiation Oncologists.

However, the issues that wagy27 mentioned have been in place for several years (and every graduating class of seniors gripe about them). Namely:

1. Saturated job markets in desirable locations
2. Uncertain future of health care reform

A couple of years ago, when the market collapsed, many seniors were complaining that retiring Radiation Oncologists started to delay their exit from medicine (and thereby didn't create open positions) due to evaporation of their 401k and other investment vehicles.

None of this stuff is really specific to Rad Onc, more to medicine in general, particularly specialists. So if you've already put in the time, effort and money to complete four years of med school you should practice in whatever specialty makes you happy.

 

[inyoface]

The public might not like it but they've been complaining about derm for years and I haven't seen changes and the dermatologists around here still have the nicest cars in the lot.

It's public statements like these that result in CMS taking notice of our reimbursement rates and slashing them accordingly.

I completely agree with GFunk that these trends seem to exist in all of the specialized fields, and given that we are all worried about job security, it's reasonable to be concerned. However, suggesting that we should explicitly limit our labor supply to protect our wallets, even if that means falling short of the epidemiologic need for cancer care, raises serious ethical concerns.

A better approach would be to find or create more value within our specialty so that demand for our services "catches up." This could include making a power play for other modalities such as HIFU, or better yet, expanding the scope of what we do for patients so that we can take referrals on new cancer patients primarily (the A. Zietman approach of becoming "general oncologists" who know radiation and a thing or two about the other modalities). There are many approaches.

And if the private market is not hiring now due to uncertainties about the economy/regulatory situation, there is reason to believe that both will be less of an issue 5 years from now at the latest. Implementation on the Affordable Care Act is set to begin in full force in 2013, and there are several competing factors which make the overall financial picture for rad oncs look either better or worse (i.e., universal insurance means increased demand for cancer care for all who need it, but accountable care/bundled payments will translate into us having to do more with less). But that aspect of things will become more clear soon enough.

 

[medgator]

expanding the scope of what we do for patients so that we can take referrals on new cancer patients primarily (the A. Zietman approach of becoming "general oncologists" who know radiation and a thing or two about the other modalities). There are many approaches.

In the private setting, especially in a free-standing practice, this is often how effective rad oncs market themselves to PCPs/pulmonologists/breast surgeons etc rather than depending on med onc referrals.

As for whether we are training too many, it's certainly a valid concern. Many practicing rad oncs can tell you about how rough the job market was back in the early-to-mid 90s. From what I understand, that pretty much shut down/scaled back a number of programs and lead to a lengthening of residency from a 3-year to a 4-year track. Not sure if that's the true reason why, but it's what I've heard.

 

[RadOncDoc21]

I understand your concerns but most places take an avg of 2 residents a yr... Would that mean programs cut back to just 1 or none? I couldn't imagine doing pgy-2 alone... Although I know a lot of people do.

-R

 

[seper]

On a side note, private practice Pathology sounds like a very outmoded concept.

 

[Sheldor]

I posted the link in he match stats thread, but it looks like there were 156 positions in Rad Onc offered through the match this year. Not sure if this is down from the year previous?

 

[Seldon1985]

I posted the link in he match stats thread, but it looks like there were 156 positions in Rad Onc offered through the match this year. Not sure if this is down from the year previous?

I don't think its just 156. Its actually all of the advanced + categorical positions, so 156 + 15 = 171. I believe that's higher than last year when I applied.

 

[Sheldor]

I don't think its just 156. Its actually all of the advanced + categorical positions, so 156 + 15 = 171. I believe that's higher than last year when I applied.

Good catch, sorry about that.